History:
A 20 year old female presented to her general practitioner (GP) after suffering from a 24 hour bout of a productive cough which had got worse throughout the night. She was previously fit and well and visited the gym regularly. She was asked to provide a sputum sample by the doctor. The sputum was coloured yellow / green.
Examination:
Her chest sounds indicated a harsh rubbing and dull percussion notes on one side of the chest. The GP noted her basic observations at the surgery:
(Day) temperature: 38.1?C
Blood pressure: 130/90 mmHg
Pulse rate: 120 bpm
Heart sounds: normal
Investigations:
The GP sent venous blood and sputum samples to pathology. The patient was referred for a chest X-ray.
Biochemistry test results:
|
Protein
|
Result
|
Normal Range
|
High (), normal (®) or low (¯)
|
|
C-reactive protein
|
13mg/l
|
|
|
|
Creatine kinase
|
61 IU/l
|
|
|
Haematology test results:
|
Pathological test
|
Patient Result
|
Normal Range
|
High (), normal (®) or low (¯)
|
|
Erythrocyte count
|
4.9 x1012/l
|
|
|
|
White blood cell count
|
15 x109/l
|
|
|
|
Neutrophils
|
8.4 x109/l
|
|
|
|
Lymphocytes
|
3.0 x109/l
|
|
|
|
ESR
|
9 mm/hr
|
|
|
Microbiology results:
A sputum sample was obtained and was noted to be yellow-green in colour. The sputum sample was submitted for microscopy and culture.
Sputum Stain
Slides were prepared from the patient's sputum and then stained:
Pus cells: +++
Red blood cells: +
Organisms: Gram negative bacilli seen
Key:
- no cells seen
+/- 1-3 cells per field (scanty)
+ 4-10 cells per field (light)
++ 11-20 cells per field (moderate)
+++ >20 cells per field (heavy)
Sputum Culture:
Blood agar: heavy growth of large flat colonies, rough blue/grey sheen. Beta haemolytic.
Cysteine lactose electrolyte deficient (CLED) agar: heavy growth - green, matt, rough colonies.
Anaerobic agar: no growth
Antibiotic Profile
The organism had the following antibiotic profile:
Ampicillin - resistant
Gentamicin - sensitive
Augmentin - resistant
Ciprofloxacin - sensitive
What do you need to do?
(1) From your research of the history and examination (not the investigation results), produce a differential diagnosis (list of possible causes) of at least two common diseases. Explain how you reached your differential diagnosis. Name six other symptoms (not listed in the history) that the patient might experience?
(2) Complete the tables of the biochemistry and haematology results
Give the normal ranges for the biochemistry results. Indicate whether the results were high (), normal (®) or low (¯). Do not add cells to the table. Provide explanations for these results in a short paragraph.
(3) Choose and describe ONE pathology test which has been performed (400 words, 20 marks)
Make clear reference to the pre-analytical, analytical and post-analytical stages of processing. Make sure that this is a PATHOLOGY test i.e. would be performed by one of the clinical disciplines in the pathology service. You cannot describe the chest X-ray in this section.
(4) Interpretation of data
Identify and explain the diagnosis of the patient with reference to the results of all of the investigations provided.
(5) Answer the following questions
(a) Describe the abnormality in the chest X-ray.
(b) List five classes of antibiotics that might be used as treatments; give one example of a drug from each class.
(c) Describe the following issues regarding antibiotic treatment of the patient: route; combination therapy; and drug resistance.
(d) Name three other organs that can be infected by the cause of this illness
(e) Name one disease that this opportunist infection often complicates. Hence, name one further investigation that you would ask to be performed for this patient.
(6) Provide a list of references